Pediatric Breast Pathologies: 5-Year Experience and Proposal for a Risk-Based Management Algorithm

Area of Science:

• Pediatric Surgery
• Pediatric Radiology
• Pediatric Oncology

Background:

• Breast complaints in children are uncommon, lacking standardized management guidelines.
• Adult protocols are often applied to pediatric patients, despite developmental differences.
• A need exists for evidence-informed pediatric breast lesion management.

Purpose of the Study:

• To review institutional experience with pediatric breast complaints.
• To propose a practical, evidence-informed diagnostic and management algorithm.
• To guide the evaluation and management of breast masses in children.

Main Methods:

• Retrospective review of female pediatric patients (2020-2025) with breast complaints.
• Analysis of demographic, clinical, imaging, treatment, and histopathological data.
• Evaluation of 293 patients, with a mean age of 14.2 years.

Main Results:

• Most common complaints: pain (47.4%) and palpable mass (41.9%).
• Ultrasonography detected masses in 68.6%; 81% remained stable or regressed without surgery.
• Histopathology confirmed benign lesions: fibroadenoma (55.6%), phyllodes tumor (22.2%), etc. No malignancies found.

Conclusions:

• Pediatric breast lesions are predominantly benign, manageable conservatively with surveillance.
• A stepwise, risk-stratified algorithm can guide evaluation, minimizing unnecessary interventions.
• Magnetic Resonance Imaging is valuable for indeterminate cases; conservative management is key.